Healthcare Provider Details

I. General information

NPI: 1851316707
Provider Name (Legal Business Name): SAINT MARIAM MEDICAL CLINIC,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 BARRANCA PKWY STE 204
IRVINE CA
92604-4687
US

IV. Provider business mailing address

4950 BARRANCA PKWY STE 204
IRVINE CA
92604-4687
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-1871
  • Fax: 949-857-1879
Mailing address:
  • Phone: 949-857-1871
  • Fax: 949-857-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA68093
License Number StateCA

VIII. Authorized Official

Name: DR. HANAA FAM
Title or Position: OWNER
Credential: M.D.
Phone: 949-857-1871